Resuscitation Flashcards

Question

Local Anaesthesia Tox Symptoms / Diagnosis

Answer 1

1. Pericardotomy & release of tamponade 2. Identification and closure of cardiac laceration 3. Compression/cross-clamping of descending thoracic aorta 4. Internal cardiac compressions 5. Management of pulmonary haemorrhage (hilar twist or tie off vessels) 6. Control of bronchovenous air embolism 7. Right atrial catheterisation facilitating IV fluids/blood products administration

Answer 2

1. Cardiac tamponade 2. Penetrating chest trauma + cardiac arrest \< 10mins 3. Vascular injury at thoracic outlet 4. Traumatic loss of chest wall 5. Massive air leak form chest tube 6. Massive or continuing haemothorax a. Stable > 200ml/hr for 3 hours or > 1500mls b. Unstable > 100mls/hr or > 1000mls 7. Mediastinal traversing penetrating injury 8. Oesophageal injury - OGD or CT 9. Tracheo-brachial injury - endoscopy of CT 10. Great vessel injury 11. Thoracic penetration with industrial liquids esp coal tar

Answer 3

1. Blunt injury + TCA w/o evidence of tamponade 2. Non-survivable injuries 3. Alternative option with non-surgical resuscitation

Answer 4

1. Tension PTx 2. Traumatic PTx 2. Moderate to large PTx 3. Bilateral PTx (regardless of size) 4. Assoc haemothorax 3. Respiratory distress 4. Failed conservative Mx 5. Recurrence after ICC removal 6. Pt requires PPV or GA

Answer 5

1. Iatrogenic 2. FB 3. Caustic burns 4. Blunt or penetrating trauma 5. Spont rupture (Boerhaave's) 6. Post-op breakdown of an anastamosis

Answer 6

1. Spont pneumomediastinum 2. Aortic aneurysm (thoracic) 3. PE 4. Perforated peptic ulcer 5. MI 6. Pneumonia 7. Pancreatitis 8. Cholecystitis 9. Mesenteric thrombosis

Answer 7

More likely with: Younger pt <30yrs > 3L pleuralfluid aspiration Large PTx > 7 days duration of pl effusion Prevention <1.5L pleural fluid drained at a time or slow to 500ml/hr Avoid suction

Answer 8

Severe allergic reaction w/ skin + A/B/C/GI symptoms Preciptants Foods: Nuts, cow milk, egg, soy, shellfish, wheat Bites/Stings: bee, wasp, jack jumper ants, ticks Meds: B-Lactams, NSAIDs Other: Exercise, Rubber/Latex (gloves, bottle nipples, dummies) RF for fatal anaphylaxis * Delay in treatment * Poorly controlled asthma * Allergy to nuts / shellfish / drugs/ insect stings * Adolescence * Preexisting cardiac and resp disease Rx * Remove allergen * Adrenaline * 10mcg/kg IM x 2 * Infusion of 1mg in 100mls Saline at 60-120mls/hr (10-20mcg/min) * Neb 5mg 1:1000 * HF O2 + nebulised adrenaline 5mg * Call for help - ICU / anaesthetics * ETT early w/ difficult airway set up + surgical airway * IV access +/- IVF bolus 10-20mg/kg * IV hydrocortisone 4mg/kg QID * Loratidine 2.5-10mg PO Discharge Instructions: Home when vitals normal Asymptomatic or observation period 6 hours Epipen and instructions Referral to Immunologist / Allergen specialist - Anyone discharged home with Epipen - Food/drug/exercise induced - Severe reaction with no trigger

Answer 9

Adrenaline – 0.1-1 microgs/kg/min Dexmedetomidine – 0.2-0.7 microgs/kg/h Dobutamine – 1-20 microgs/kg/min Dopamine – 1-20 microgs/kg/min GTN – 0.1-0.8 microgs/kg/min Ketamine – analgesia: 0.05-0.1 mg/kg/h, sedation: 0.2 mg/kg/h Lignocaine – 1.5 mg/kg/h Noradrenaline – 0.1-1 microgs/kg/min Phenylephrine – 0.1-2 microgs/kg/min Propofol – 4-12 mg/kg/h or 75-175 microgs/kg/min

Answer 10

1. Adrenaline - lactic acidosis, low K, low PO4 2. NA - reflex bradycardia, HTN, peripheral ischaemia 3. Dobutamine - tachyarrhytmia, tachyphylaxis, AMI 4. Dopamine - arrhythmia, pulmonary vasoconstriction, N+V, immune dysregulation, TSH and Prolactin release 5. Vasopression - PHTN, splanchnic ischaemia, uterine contraction

Answer 11

Determine disease resolution Airway / ETT not difficult else best in ICU Readiness 1. Drug reversal a. Turn off sedative / muscle relaxants b. Absent inotrope requirement 2. Stable Resp physiology a. FiO2 <30% b. No resp acidosis c. Spontaneous breathing trial - minimise ventilatory support i. Good TV, sats, RR 3. Stable cardiac physiology a. Stable rate and rhythm b. Low dose or absent inotropic support 4. Stable CNS a. Strength - lift head off pillow, raise arms for 15 seconds b. Mentation - eyes open to voice, obeying commands Preparation Sit up 45 degrees High flow O2 100% Equipment to re-intubate Apply positive pressure - ask pt to inhale Remove ETT as pt coughs / exhales Suction orpharynx Post ETT care High flow O2 Hudson Reassess adequacy of ventilation - HFNP or NIV for respiratory distress - ETT if above fails Close observation for 60mins

Answer 12

Indications * Bridge to recovery - unable to wean cardiac bypass * Bridge to cardiac transplant * Bridge to decision * Destination therpay - not eligible for cardiac Tx CI Metastatic cancer Cerebral accident Irreversible hepatic or renal disease Relative CI Active coagulopathy Active infection Mechanical cardiac valves Severe AR Components 1. Inflow cannula (from left ventricle) 2. Blood pump 3. Outflow conduit (anastomosed to ascending aorta) 4. Percutaneous lead (drive line) 5. External system components (controller, monitor, power source and battery) How it works Blood flows from heart to VAD which pumps blood back to body Provides partial or total circulatory assistance LVAD, RVAD or BiVAD

Answer 13

**VAD-related** suckdown malposition pump failure/ obstruction (thrombosis, kinking, etc) excessive pump speed **Non-VAD-related** hypovolemia (dehydration or haemorrhage) cardiac tamponade aortic regurgitation dysrhythmias vasodilation

Answer 14

Initial - RHF, bleeding/clotting/suckdown Device related - suckdown, failure, malposition, migration CVS - RH dysfunction, AR, dysrrhytmias, CVA Haem - bleeding, thromboemolbism, haemolysis, VAD thrombosis, acquired VWF dysfunction Infection Anti-coagualtion complications - GIH, ICH

Answer 15

**CALL VAD CENTRE EARLY** All anticoagulated and can presnet with GIH or ICH Can dvp acquired Von Willebrand's PLT dysfunction Dysrrhythmias frequent so pts have AICD LVAD * Sats may be unreliable due to low pulse pressure * Some - No palpable pulse or BP * MAP with art line * BP cuff - constant flow indicates MAP * Assess other vitals for perfuson status * Shock may be RVF - deviced does not support RV - consider dobutamine, dopamine * Compressions NOT HELPFUL - confirm absence of pump function and fix malfunction * Some have backup hand pump TAH * ECG asytole as no native cardiac activity * Defib / pacing and chest compressions NOT HELPFUL

Answer 16

Actions Increases cornoary perfusion, diastolic flow Reduces afterload, LV stroke work, myocardial O2 demand, R-> L shunt in VSD, degree of MR Indications Cardiogenic shock and myocardial ischaemia - Post MI - Cardioomyopathy - Severe iHD awaiting curgery - Severe acute MR waiting surgery - Prophylactic in high risk pt Unable to wean of cardiopulmonary bypass CI Severe AR Aortic dissection Severe PVD, AAA, AAA repair Sepsis Severe coagulopathy CI < 1.2 Tachyarrhytmias Components Large bore catheter w/ long sausage shaped balloon at distal tip Console w/ pump that inflates balloon Complications **Insertion** Insertion failure, malposition Aortic dissection or arterial puncture, accidental femoral vein puncture **Use** Infection Thrombosis - Limb ischaemia Embolisation - end-organ ischaemia Bleeding at insertion site Gas embolism Balloon rupture Haemolysis and thrombocytopaenia Anti-coagulation issues

Resuscitation Flashcards

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